Treatments for Bipolar Disorder in Children

For almost 60 years, the Department of Psychiatry at Boston Children's Hospital has been a leader i in the mental health care of children, adolescents and their families, delivering leading-edge care, research and advocacy. .

Our experienced psychiatrists, psychologists, social workers and nurses understand the wide-reaching impact of a child's bipolar disorder, and we will give your child and family all of the tools you need to manage your unique situation.

How is bipolar disorder treated at Children's?
We typically treat bipolar disorder through a combination of:

psychotherapy, or “talk therapy”

medication

family support

systems interventions (at school and in the community) as needed

Children's approach to mental health care is evidence-based—which means that our treatments have been tested and proven effective through scientific studies, both here at our hospital and by other leading institutions worldwide.

Psychotherapy

Psychotherapy, or “talk therapy,” is designed to help your child learn the best ways to identify and respond to his manic and depressive symptoms when they occur.

recognize that the “high high” and “low low” feelings he's experiencing are caused by his bipolar disorder

change his negative and potentially harmful thoughts, feelings and behaviors (this process is called cognitive behavioral therapy or CBT)

learn new and healthy ways of relating to his family members, teachers and peers

build his self-esteem and define himself as much more than his illness

become an active member in their own care “team”

In addition, family counseling can help you and your child's other loved ones learn how to live with and manage the ups and downs arising from his bipolar disorder.

Medication

Unfortunately, no matter how hard you or your child try, most often it's not possible to stop mood episodes with talk therapy or willpower alone.

Just like a congenital heart defect or asthma, bipolar disorder is a medical condition, and a biological process or imbalance is responsible for it. In almost every case, the best way to correct this faulty biological process is through medication. Here at Children's, our Psychopharmacology Clinic is devoted to helping children, families and clinicians incorporate medication into a treatment plan.

Many people with bipolar disorder need to take medication for long periods (over several years) to best combat the illness. Though this isn't always easy, the benefits of the medication far outweigh the inconvenience and possible side effects.

There are several different medications that can be prescribed for bipolar disorder. Your child's treating clinician will advise you on the best choice for her and her symptoms. We will carefully go over the specifics of the drug and explain any and all of the potential benefits, alternatives and side effects that you should watch for.

Here are some of the basic facts about the various medications used to manage bipolar disorder: (Please note that the bolded medications have the best evidence of effectiveness and are supported by the U.S. Food and Drug Administration.)

Mood-stabilizing medications
Mood stabilizers are medications that stop the rapid shift from high to low moods and back again. They are particularly useful in preventing manic episodes.

Some of the most common mood stabilizers used to treat bipolar disorder are:

Antipsychotic medications
Antipsychotic medications can serve two purposes: They can act as mood stabilizers (like the drugs above), and they also can treat children who have mood episodes that are so severe that they experience a break in reality—an inability to distinguish what's real from what isn't. This is called a psychosis.

Antipsychotic medications include:

Quetiapine (Seroquel)

Aripiprazole (Abilify)

Risperidone (Risperdal)

Olanzapine (Zyprexa)

Ziprasidone (Geodon)

Antidepressant medications
Antidepressants are a class of medications that can be used to control depressive episodes in bipolar disorder. These are usually prescribed along with a mood stabilizer or antipsychotic—generally not as a standalone, since antidepressants can't manage the manic symptoms experienced by a child with bipolar disorder and may even activate or worsen mania when used alone.

Commonly prescribed antidepressants include:

Fluoxetine (Prozac)

Escilatpram (Lexapro)

Sertraline (Zoloft)

Since 2004, the U.S. Food and Drug Administration has placed a black box warning label on all antidepressant medications. The warning label states, in part:

“Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”

Parents should note that even with the above warning, almost all psychiatrists find that the benefits of antidepressants, when used properly, far outweigh the risks.

Here at Boston Children's Hospital, our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We will closely monitor your child for any sign of a negative response to her medication, and are always here to address any concerns you may have.

Is bipolar disorder ever considered “cured”?
This is not clear at this time. Although the condition responds to treatment in most cases, bipolar disorder is generally seen as a chronic (long-lasting) disease that may come and go for many years.

Your child will need to follow the treatment plan outlined by her care team, and any changes should be carefully discussed among all members of her treatment team.

Coping and support

The ups and downs experienced by a child—and family—living with bipolar disorder can feel overwhelming. In addition to the information provided here, you may find comfort and support from the following resources

Patient and family resources at Children's

Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center's services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

The Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.

The Experience Journal was designed by Children's psychiatrist-in-chief David DeMaso, MD, and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers dealing not only with physical illnesses, but also with such mental health conditions.

Children's Integrative Therapies Team provides a number of services for hospitalized children, their families and their caregivers, including:

Helpful links

Please note that neither Boston Children's Hospital nor the Children's Department of Psychiatry unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

Young men and young women may have certain concerns that are specific to their genders, and some concerns that they share. At Children's, the Center for Young Women's Health and Young Men's Health Site offer the latest general and gender-specific information about issues including fitness and nutrition, sexuality and reproductive health, physical development and emotional well-being.

Boston Children's Hospital has been named the #1 children's hospital in the nation by U.S. News and World Report for the fifth year in a row! It's an honor that we could not have achieved without you. On behalf of every member of our Boston Children's team, thank you for inspiring us to be bolder, dream bigger, and make the impossible possible for our patients and families.